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Well-Child Checkup: 4 Years

Even if your child is healthy, keep taking him or her for yearly checkups. This ensures your child’s health is protected with scheduled vaccinations and health screenings. Your health care provider can make sure your child’s growth and development is progressing well. This sheet describes some of what you can expect.

Bicycle safety equipment, such as a helmet and reflectors, help keep your child safe.

Development and milestones

The health care provider will ask questions and observe your child’s behavior to get an idea of his or her development. By this visit, your child is likely doing some of the following:

Enjoy and cooperate with other children

Talk about what he or she likes (for example, toys, games, people)

Tell a story, or singing a song

Recognize most colors and shapes

Say first and last name

Use scissors

Draw a person with 2 to 4 body parts

Catch a ball that is bounced to him or her, most of the time

Stand briefly on one foot

School and social issues

The health care provider will ask how your child is getting along with other kids. Talk about your child’s experience in group settings such as preschool. If your child isn’t in preschool, you could talk instead about behavior at daycare or during play dates. You may also want to discuss preschool options and how to help prepare your child for kindergarten. The health care provider may ask about:

Behavior and participation in group settings. How does your child act at school (or other group setting)? Does he or she follow the routine and take part in group activities? What do teachers or caregivers say about the child’s behavior?

Behavior at home. How does the child act at home? Is behavior at home better or worse than at school? (Be aware that it’s common for kids to be better behaved at school than at home.)

Friendships. Has your child made friends with other children? What are the kids like? How does your child get along with these friends?

Play. How does the child like to play? For example, does he or she play “make believe”? Does the child interact with others during playtime?

Independence. How is your child adjusting to school? How does he or she react when you leave? (Some anxiety is normal. This should subside over time, as the child becomes more independent.)

Nutrition and exercise tips

Healthy eating and activity are two important keys to a healthy future. It’s not too early to start teaching your child healthy habits that will last a lifetime. Here are some things you can do:

Limit juice and sports drinks. These drinks — even pure fruit juice — have too much sugar, which leads to unhealthy weight gain and tooth decay. Water and low-fat or nonfat milk are best to drink. Limit juice to a small glass of 100% juice each day, such as during a meal.

Don’t serve soda. It’s healthiest not to let your child have soda. If you do allow soda, save it for very special occasions.

Offer nutritious foods. Keep a variety of healthy foods on hand for snacks, such as fresh fruits and vegetables, lean meats, and whole grains. Foods like French fries, candy, and snack foods should only be served rarely.

Serve child-sized portions. Children don’t need as much food as adults. Serve your child portions that make sense for his or her age. Let your child stop eating when he or she is full. If the child is still hungry after a meal, offer more vegetables or fruit. It's OK to put limits on how much your child eats.

Encourage at least 30 minutes to 60 minutes of active play per day. Moving around helps keep your child healthy. Bring your child to the park, ride bikes, or play active games like tag or ball.

Limit “screen time” to 1 hour to 2 hours each day. This includes TV watching, computer use, and video games.

Ask the health care provider about your child’s weight. At this age, your child should gain about 4 pounds to 5 pounds each year. If he or she is gaining more than that, talk to the health care provider about healthy eating habits and activity guidelines.

Take your child to the dentist at least twice a year for teeth cleaning and a checkup.

Safety tips

When riding a bike, your child should wear a helmet with the strap fastened. While roller-skating or using a scooter or skateboard, it’s safest to wear wrist guards, elbow pads, and knee pads, and a helmet.

Keep using a car seat until your child outgrows it. (For many children, this happens around age 4 and a weight of at least 40 pounds.) Ask the health care provider if there are state laws regarding car seat use that you need to know about.

Once your child outgrows the car seat, switch to a high-back booster seat. This allows the seat belt to fit properly. A booster seat should be used until your child is 4 feet 9 inches tall and between 8 and 12 years of age. All children younger than 13 years old should sit in the back seat.

Teach your child not to talk to or go anywhere with a stranger.

Start to teach your child his or her phone number, address, and parents’ first names. These are important to know in an emergency.

If you have a swimming pool, it should be entirely fenced on all sides. Gates or doors leading to the pool should be closed and locked. Do not let your child play in or around the pool unattended, even if he or she knows how to swim.

Vaccinations

Based on recommendations from the Centers for Disease Control and Prevention (CDC), at this visit your child may receive the following vaccinations:

Diphtheria, tetanus, and pertussis

Influenza (flu), annually

Measles, mumps, and rubella

Polio

Varicella (chickenpox)

Give your child positive reinforcement

It’s easy to tell a child what they’re doing wrong. It’s often harder to remember to praise a child for what they do right. Positive reinforcement (rewarding good behavior) helps your child develop confidence and a healthy self-esteem. Here are some tips:

Give the child praise and attention for behaving well. When appropriate, make sure the whole family knows that the child has done well.

Reward good behavior with hugs, kisses, and small gifts (such as stickers). When being good has rewards, kids will keep doing those behaviors to get the rewards. Avoid using sweets or candy as rewards. Using these treats as positive reinforcement can lead to unhealthy eating habits and an emotional attachment to food.

When the child doesn’t act the way you want, don’t label the child as “bad” or “naughty.” Instead, describe why the action is not acceptable. (For example, say “It’s not nice to hit” instead of “You’re a bad girl.”) When your child chooses the right behavior over the wrong one (such as walking away instead of hitting), remember to praise the good choice!